By Philip Dorling

Need a new liver? Why not head to France. A hip replacement? Japan could be the place for you.

According to a leaked document, the highly secretive Trade in Services Agreement (TiSA) negotiations that will resume in Geneva on Monday will include discussion of wide-ranging reforms to national public health systems to promote "offshoring" of health care services.

Trade Minister Andrew Robb.Credit:Sanghee Liu

But health unions and trade experts say the negotiations, which are being led by Australia, the US and the European Union, could lead to massive growth of "medical tourism" to the detriment of investment in Australian public hospitals and local healthcare.

The leaked discussion paper – published by the non-government organisations Associated Whistle-Blowing Press and Public Services International – has for the first time revealed TiSA countries including Australia are actively discussing measures to boost the "cross-border delivery of health services".

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"Thanks to the secrecy that's surrounded these talks, we haven't known what is being negotiated in our name, and the Australian public haven't been aware of the potentially huge health implications," said Michael Whaites, NSW Nurses and Midwives' Association organiser and spokesman.

"You can ask whether the government is working in a co-ordinated manner, and indeed what is their real intention on the future of Medicare?"

The leaked "concept paper on health care services within TISA negotiations," reportedly tabled by the Turkish government in negotiations in Geneva last September, argues there is "huge untapped potential for the globalisation of healthcare services," creating massive business opportunities from what is a $US6 trillion ($7.7 trillion) per year industry.

The proposed regime would involve health professionals authorising patients to be treated in other TiSA countries (for reasons including long waiting times in the home country or inadequate expertise for specific medical problems); and the patients's costs being reimbursed through their home country's social security system, private insurance coverage or other healthcare arrangements.

According to the Department of Foreign Affairs and Trade, a further TiSA negotiation round in December 2014 made "good progress" in dealing with issues that included "facilitation of patient mobility".

However, Professor Jane Kelsey, an expert on trade in services at the University of Auckland, warned that health-service-exporting countries such as Australia would find that qualified staff are diverted to health export services "that often have better pay and facilities, eroding the personnel base for public facilities and perpetuating inequalities in the health care system".

Education and training investments may also be diverted "to benefit foreign healthcare users, rather than local citizens and taxpayers".

Tony Abbott and Joe Hockey have been saying that healthcare expenditure is unsustainable, but Andrew Robb is quietly engaged in negotiations that could potentially see scarce healthcare dollars going overseas

Fifty countries including Australia, Canada, Japan, South Korea, Taiwan, the EU (representing its 28 member countries) and the US are engaged in the TiSA negotiations, which began in 2013.

Mr Robb said the TiSA will "strengthen job-creating services" and that the Australian government wants an agreement "that supports each party's right to protect public health".

"As is common practice with many negotiations on international treaties, draft negotiating texts of the TiSA are not public documents," Mr Robb wrote in a letter to the nurses and midwives' union.